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Clinical Endocrinology

Clinical characteristics of Graves' orbitopathy in patients showing discrepancy between levels from TBII assays and TSI bioassay

Authors

  • Sun Young Jang,

    1. Department of Ophthalmology, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
    2. Yonsei University Graduate School of Medicine, Seoul, Korea
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  • Dong Yeob Shin,

    1. Department of Endocrinology, Brain Korea 21 Project for Medical Science, Institute of Endocrine Research and Severance Integrative Research Institute for Cerebral & Cardiovascular Disease, Yonsei University College of Medicine, Seoul, Korea
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  • Eun Jig Lee,

    1. Department of Endocrinology, Brain Korea 21 Project for Medical Science, Institute of Endocrine Research and Severance Integrative Research Institute for Cerebral & Cardiovascular Disease, Yonsei University College of Medicine, Seoul, Korea
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  • Jin Sook Yoon

    Corresponding author
    1. Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
    • Correspondence: Dr. Jin Sook Yoon, Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea. Tel.: 82 2 2228 3570; Fax: 82 2 312 0541; E-mail: yoonjs@yuhs.ac

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Abstract

Objective

To investigate clinical characteristics of patients with Graves' orbitopathy (GO) who showed discrepancies between levels of thyroid-stimulating immunoglobulin (TSI) and thyrotropin-binding inhibitory immunoglobulin (TBII).

Design

Comparative case series.

Patients

A total of 317 patients with GO in whom Mc4-TSI and M22-TRAb (third-generation TBII) were measured simultaneously. Patients were divided into four groups according to TRAb levels as followings: Group 1, TBII and TSI < median value; Group 2, TBII ≥ median, TSI < median; Group 3, TBII < median, TSI ≥ median; Group 4, both TBII and TSI ≥ median.

Measurement

Endocrine and ophthalmic clinical manifestations in each group.

Results

The median value of M22-TRAb was 6·11 IU/l and that of Mc4-TSI was 415·1 (SRR%). One hundred seventeen patients were classified as Group 1, 41 patients as Group 2, 41 patients as group 3 and 118 patients as group 4. Mean CAS was significantly higher in Groups 3 (2·2) and 4 (2·2) than in Groups 1 (1·6) and 2 (1·4; = 0·001, anova). Mean modified NOSPECS scores were significantly higher (< 0·001, anova) in Groups 3 (4·1) and 4 (4·1) than in Groups 1 (3·1) and 2 (2·3). The proportion of patients with hyperthyroidism was larger in Group 2 (85·4% [35/41 patients]) than in Group 3 (48·8% [20/41 patients]; = 0·002).

Conclusions

GO is more active and severe in patients with predominant Mc4-TSI than in patients with predominant M22-TRAb. Patients with hyperthyroidism were more likely to be included with patients with predominant M22-TRAb than with predominant Mc4-TSI.

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